A narrative review of the impact of ultraviolet radiation and sunscreen on the skin microbiome.

BACKGROUND: The human skin microbiome is a dynamic ecosystem that plays an important role in skin health. The skin microbiome has been implicated in numerous diseases, and our knowledge surrounding it continues to evolve. A better understanding of the interactions between the environment and the skin microbiome will lead to improvements in skin health. METHODS: This article reviews the published literature surrounding the impact of ultraviolet radiation (UVR) and sunscreen on the skin microbiome. RESULTS: Skin microbes are differentially impacted by UVR, and alterations in the microbiome can be detected following UVR exposure. These changes are related to direct bactericidal effects, alterations in the cutaneous metabolome, and changes in the cutaneous immune system. UV filters used in sunscreen have been shown to have bactericidal effects, and many compounds used in sunscreen emulsions can also negatively impact cutaneous microbes. CONCLUSION: A healthy microbiome has been shown to produce compounds that help protect the skin from UVR, and sunscreen has the potential to reduce the diversity of the skin microbiome. This indicates that designing sunscreen products that both provide protection against UVR and preserve the skin microbiome may offer additional benefits to skin health when compared with traditional sunscreen products.

Practical guidelines for the treatment of vitiligo with the melanocyte-keratinocyte transplantation procedure.

Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.

The development of non-scarring alopecia in women who wear the hijab.

Little is known about hair loss associated with wearing the hijab, a religious head covering worn by Muslim women. We performed a single-center analysis to investigate the association between various forms of non-scarring alopecia and wearing the hijab. This study included 125 patients who wore the hijab and 40 race/ethnicity-matched women who did not wear the hijab. Among the 165 total patients diagnosed between January 2015 and March 2022, 71 had telogen effluvium, 78 had female pattern hair loss, and 16 had traction alopecia. We found patients who wore the hijab had a younger mean age of alopecia onset than patients who did not wear the hijab (31.5 vs. 37.3 years; P = 0.02). Our study suggests that vitamin D deficiency (OR 4.1; 95% CI 1.2-14.1; P = 0.02) and seborrheic dermatitis (OR 2.9; 95% CI 1.1-8.1; P = 0.03) may significantly impact the development of telogen effluvium in patients who wear the hijab. Targeting these risk factors among patients who wear the hijab may be considered to prevent hair loss.

Optimisation of skin phototype classification.

Understanding individuals' skin pigmentation and photosensitivity is important in judging risk of skin cancer and response to certain treatment modalities. However, individuals with darkly pigmented skin are poorly represented in the widely used Fitzpatrick skin phototype (FST) system. Moreover, the FST system is prone to misuse, as it relies on subjective patient and clinician assessment of skin type, and does not clearly differentiate pigmentation from photosensitivity. By evaluating the key literature surrounding the FST system, its criticisms and proposed alternatives, this review serves to understand how skin phototype classification can be optimised.

The effects of UV filters on health and the environment.

Sunscreens are an important means of protection against sunburns, dyspigmentation, photoaging, and photocarcinogenesis. Sunscreens come in a variety of formulations that can protect against ultraviolet B (UVB) radiation, both UVB and ultraviolet A (UVA) radiation (broad-spectrum sunscreens), and UVB, UVA, and visible light (tinted broad-spectrum sunscreens). In the USA, there is currently a paucity of FDA-approved broad-spectrum filters on the market. Studies have identified the presence of multiple UV filters in water sources globally. Many laboratory studies have implicated the potential impact of UV filters on coral reef bleaching, the food chain, and human health. However, many of these studies are performed at concentrations that are much higher than those present in the natural environment. With increasing discussion surrounding the role of organic and inorganic UV filters as potential environmental pollutants over the past decade, approval of additional broad-spectrum filters would be an important means of alleviating the use of more controversial filters. The aim of this article is to review the effects of UV filters on health and the environment and explore potential adjunctive agents for photoprotection.

Targeting tyrosinase in hyperpigmentation: Current status, limitations and future promises.

Hyperpigmentation is a common and distressing dermatologic condition. Since tyrosinase (TYR) plays an essential role in melanogenesis, its inhibition is considered a logical approach along with other therapeutic methods to prevent the accumulation of melanin in the skin. Thus, TYR inhibitors are a tempting target as the medicinal and cosmetic active agents of hyperpigmentation disorder. Among TYR inhibitors, hydroquinone is a traditional lightening agent that is commonly used in clinical practice. However, despite good efficacy, prolonged use of hydroquinone is associated with side effects. To overcome these shortcomings, new approaches in targeting TYR and treating hyperpigmentation are desperately requiredessentialneeded. In line with this purpose, several non-hydroquinone lightening agents have been developed and suggested as hydroquinone alternatives. In addition to traditional approaches, nanomedicine and nanotheranostic platforms have been recently proposed in the treatment of hyperpigmentation. In this review, we discuss the available strategies for the management of hyperpigmentation with a focus on TYR inhibition. In addition, alternative treatment options to hydroquinone are discussed. Finally, we present nano-based strategies to improve the therapeutic effect of drugs prescribed to patients with skin disorders.

Recipient-to-Donor Ratios in the Surgical Treatment of Vitiligo, Leukoderma, and Piebaldism: A Retrospective Review.

BACKGROUND: The autologous noncultured melanocyte keratinocyte transplant procedure (MKTP) has emerged as a popular grafting technique with proven efficacy for achieving repigmentation. However, there remains no consensus regarding the optimal recipient-to-donor (RD) ratio required to achieve acceptable repigmentation. In this retrospective cohort study of 120 patients, we sought to examine whether expansion ratios impact the repigmentation success rates following MKTP. RESULTS: A total of 69 patients (mean [SD] age was 32.4 [14.3] years, mean follow-up was 30.4 [22.5] months, 63.8% were male; 55% were dark-skinned individuals [Fitzpatrick IV-VI]) were included. The mean percent change in the Vitiligo Area Scoring Index (VASI) was 80.2 (±23.7; RD of 7.3) in patients with focal/segmental vitiligo (SV), 58.3 (±33.0; RD of 8.2) in those with non-segmental vitiligo (NSV), and 51.8 (±33.6; RD of 3.7) in those with leukoderma and piebaldism. Focal/SV was positively associated with a higher percent change in VASI (parameter estimate: 22.6, p value <0.005). In the SV/focal group, non-white patients had a higher RD ratio compared to White individuals (8.2 ± 3.4 vs. 6.0 ± 3.1, respectively, p value = 0.035). DISCUSSION: In our study, we found that patients with SV were significantly more likely to achieve higher repigmentation rates compared to those with NSV. Although repigmentation rates were higher in the low expansion ratio group than in the high expansion ratio group, we did not observe a significant difference between the two groups. CONCLUSION: MKTP is an effective therapy for restoring repigmentation in patients with stable vitiligo. Therapeutic response of vitiligo to MKTP appears to be influenced by the type of vitiligo, rather than a specific RD ratio.

Demographics and clinical presentations of 844 patients with light and dark skin types with polymorphous light eruption and chronic actinic dermatitis evaluated over 23 years.

INTRODUCTION: Polymorphous light eruption (PMLE) and chronic actinic dermatitis (CAD) have been classically described in White individuals, although recent studies have reported higher prevalence in patients with dark skin types, particularly African Americans. OBJECTIVE: To evaluate for differences in demographic, and clinical features between persons with light and dark skin types who have PMLE and CAD. METHODS: Retrospective review of patients with PMLE and CAD who were diagnosed from January 1, 1998, through November 31, 2021, at a single academic dermatology center. RESULTS/DISCUSSION: A total of 844 patients (725 [85.9%] female; mean [SD] age of onset: 41.7 [16.9] years) were diagnosed with PMLE, and 60 patients (22 [36.6%] female; mean age, [SD]: 60.6 [10.6] years) of age at presentation, disease duration of 8.2 [7.3] years were diagnosed with CAD. Although just over 50% of the general clinic population was White, the prevalence of PMLE and CAD was significantly higher in dark-skinned individuals compared to light-skinned individuals (PMLE: 625 [74.0%] vs. 219 [25.9%], p value < .001; CAD: 43 [71.6%] vs. 17 [28.3%], p value = .003) respectively. The pinpoint papular variant of PMLE (PP-PMLE) was predominantly seen in dark-skinned individuals. CONCLUSION: A substantial proportion of PMLE and CAD cases are present in dark-skinned individuals. PP-PMLE can be mistaken for lichen nitidus. As such, recognition of this entity is important for adequate evaluation and management of patients with PMLE.

Disorders of hyperpigmentation. Part II. Review of management and treatment options for hyperpigmentation.

Key challenges in the management of pigmentary disorders such as melasma and postinflammatory hyperpigmentation are their resistance to treatment, tendency to recur after treatment, and the risk of exacerbating hyperpigmentation with many treatment modalities. The second article in this 2-part continuing medical education series on pigmentary disorders focuses on the evidence behind medical and procedural treatments of dyschromias, including photoprotection, topical lightening agents, oral agents, chemical peels, and laser therapy.

Systemic therapies in vitiligo: a review.

Vitiligo is characterized by the development of depigmented macules and patches. Autoimmunity has been established as a factor in disease pathogenesis, leading to utilization of immunosuppressive agents. Topical immunosuppressants are commonly used; however, this treatment modality is often cumbersome and inefficient, as many patients have active disease with extensive body surface area involvement. Prompt and aggressive treatment of vitiligo is important, as this may prevent progression and improve quality of life. To meet these challenges and improve patient outcomes, interest in systemic therapies has grown. Currently, oral therapies are rarely prescribed, likely due to concerns with systemic side effects and unclear efficacy. This article provides a brief overview on the use of systemic agents in treating vitiligo in order to provide additional therapeutic options to clinicians.

Disorders of hyperpigmentation. Part I. Pathogenesis and clinical features of common pigmentary disorders.

Disorders of hyperpigmentation are common and, depending on the extent and location of involvement, can affect the quality of life and pose a significant psychologic burden for patients. Given the similarities in presentation of the various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is important to guide management. Furthermore, certain disorders, such as lichen planus pigmentosus and ashy dermatosis, have similar clinical and/or histologic presentations, and their classification as distinct entities has been debated upon, leading to additional confusion. In this review, the authors selected commonly encountered disorders of hyperpigmentation of the skin, subdivided into epidermal, dermal, or mixed epidermal-dermal disorders based on the location of pigment deposition, along with disorders of hyperpigmentation of the mucosa and nails. Melanocytic nevi, genetic disorders, and systemic causes of hyperpigmentation were largely excluded and considered to be outside the scope of this review. We discussed the pathogenesis of hyperpigmentation as well as the clinical and histologic features of these conditions, along with challenges encountered in their diagnosis and classification. The second article in this 2-part continuing medical education series focuses on the medical and procedural treatments of hyperpigmentation.